2017-02-01T10:23:13-07:00 2016-06-30 990 2015-07-01 310986918 Friendship Village of Dublin Ohio Inc FRIE 6147641600 6000 Riverside Drive Dublin OH 43017 Jerry Kuyoth Executive Director 6147641600 2017-02-01 2015 2021-01-29 14:40:06Z Jerry Kuyoth 6000 Riverside Drive Dublin OH 43017 21823913 0 X www.fvdublin.org X 1979 OH SEE SCHEDULE O 17 17 437 565 0 0 190993 181471 19626689 20042049 2280742 1455470 84351 75416 22182775 21754406 12150 12500 0 0 8349144 8851514 0 0 26317 10370684 11256855 18731978 20120869 3450797 1633537 98514080 102255361 64396766 68085027 34117314 34170334 To enhance the quality of life for older adults. 0 0 16302531 12500 20064540 OPERATION OF A SKILLED NURSING FACILITY WHICH HAS 60 BEDS. OPERATION OF AN ASSISTED LIVING FACILITY WHICH HAS 46 APARTMENTS. ALSO PROVIDED NON-SKILLED HOME CARE TO RESIDENTS WHO CHOOSE FOR SUPPORT. 0 0 0 16302531 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 44 0 1 437 1 0 0 0 0 0 0 0 0 0 0 0 0 X 17 17 0 1 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X Friendship Village of Dublin c/o Craig Flickinger 6147641600 6000 Riverside Drive Dublin OH 43017 RONALD BACHMAN CHAIRMAN 3.0 0 X X 0 0 0 LAURA ECKLAR CHAIRMAN - ELECT 1.50 0 X X 0 0 0 CHARLES E ANSLEY TREASURER 1.50 0 X X 0 0 0 BRUCE PAIGE SECRETARY 1.50 0 X X 0 0 0 RICHARD BAKER DIRECTOR 1.00 0 X 0 0 0 CHEREE CLARK DIRECTOR 1.00 0 X 0 0 0 KEITH DEVOE III DIRECTOR 1.00 0.00 X 0 0 0 KAREN ICKES DIRECTOR 1.00 0 X 0 0 0 CAROL JENKINS DIRECTOR 1.00 0 X 0 0 0 OWEN JOHNSON DIRECTOR 1.00 0 X 0 0 0 SHAWN KARASARIDES DIRECTOR 1.00 0 X 0 0 0 JOAN MANTER DIRECTOR 1.00 0 X 0 0 0 RICHARD SCHROCK DIRECTOR 1.00 0 X 0 0 0 MARGARET TEAFORD DIRECTOR 1.00 0 X 0 0 0 BRUCE WALL DIRECTOR 1.00 0 X 0 0 0 WILLIAM KONIEWICH DIRECTOR 1.00 0 X 0 0 0 KATHLEEN McGINNIS DIRECTOR 1 0 X 0 0 0 JAMES WINFREE DIRECTOR 1.00 0.00 X 0 0 0 JERRY KUYOTH EXECUTIVE DIRECTOR 40.00 0.00 X 195012 0 28090 CRAIG FLICKINGER DIRECTOR OF FINANCE 40.00 0.00 X 116324 0 11099 DONALD PAUL DIRECTOR OF CULINARY SERVICES 40.00 0 X 134896 0 12582 DAN NASE DIRECTOR OF MARKETING 40.00 0 X 123571 0 16384 THERESA McFARLAND DIRECTOR OF NURSING 40.00 0 X 107413 0 11881 677216 0 80036 5 0 1 0 RUSCILLI CONSTRUCTION 2041 ARLINGATE COLUMBUS OH 43017 CONSTRUCTION SERVICE 1872995 JMM ARCHITECTS 4685 LARWELL DRIVE COLUMBUS OH 43220 PROFESSIONAL SERVICES 761087 GLYNN DEVINS MARKETING & ADVERTISING 11230 COLLEGE BLVD OVERLAND PARK KS 66210 MARKETING SERVICES 570067 REHAB CARE GROUP THERAPY 680 SOUTH FOURTH STREET LOUISVILLE KY 40202 THERAPY SERVICES 539469 LIFE CARE SERVICES 400 LOCUST STREET DES MOINES IA 50309 MANAGEMENT FEE 349440 8 0 0 0 0 0 181471 0 181471 RESIDENCY SERVICES 531110 17242351 17242351 0 0 MEDICARE/MEDICAID SERVICES 531110 1729066 1729066 0 0 INSURANCE/HMO SERVICES 531110 423755 423755 0 0 HOME CARE SERVICES 621610 614520 614520 0 0 AT HOME PROGRAM 621610 32357 32357 0 0 0 0 0 0 20042049 932370 0 0 932370 0 0 0 0 0 0 0 0 144923 0 69507 0 75416 0 75416 22491 0 52925 569561 -46461 0 0 569561 -46461 523100 0 0 523100 0 0 21754406 20064540 0 1508395 12500 12500 387571 387571 0 6886835 5965787 921048 102681 74029 28652 856495 747843 108652 617932 519974 97958 349440 349440 61985 61985 53425 53425 686476 686476 3074535 2006115 1068420 182259 182259 1516714 1516714 34126 8749 25377 32602 14825 17777 1339848 1339848 2252092 1826309 424171 1612 247545 247545 FOOD 1254760 1254760 0 0 BAD DEBT EXPENSE 74263 74263 0 0 LETTER OF CREDIT FEE 72080 72080 0 0 CHARITABLE GIVING EXPENSE 24705 0 0 24705 0 0 20120869 16302531 3792021 26317 150300 150300 17114339 13016411 714855 828020 70491 68013 211828 187486 68687499 31372610 34201692 37314889 41792914 41595771 1639646 1720398 2618015 7374073 98514080 102255361 2953675 3424924 25687846 26898587 30785000 31545887 4970245 6215629 64396766 68085027 X 33223416 33171467 893898 998867 0 0 34117314 34170334 98514080 102255361 X 1633537 -1569984 0 0 0 -10533 X X 0 1 X 1 0 X 96849 131272 106482 190993 181471 707067 18253444 19083855 19155577 19626689 20042049 96161614 18350293 19215127 19262059 19817682 20223520 96868681 4065 5010 5200 5750 6840 26865 4065 5010 5200 5750 6840 26865 96841816 538281 825887 1178151 909495 932370 4384184 538281 825887 1178151 909495 932370 4384184 18888574 20041014 20440210 20727177 21155890 101252865 0.95644 0.95954 0.04330 0.04011 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 1592 1592 0 Schedule C, Part II-B, Line 1 LOBBYING ACTIVITIES: EXPLANATION: THE ORGANIZATION IS A MEMBER OF LEADING AGE OHIO; A PORTION OF THE DUES PAYMENTS TO LEADING AGE OHIO GOES TOWARDS LOBBYING ACTIVITIES. MEMBERSHIP DUES IN THE AMOUNT OF $17,500 WERE PAID TO LEADING AGE OHIO: 9.1% ($1,592) OF THE DUES RELATED TO LOBBYING. 893898 131839 37950 12500 52320 0 998867 759881 144459 22570 12150 20862 0 893898 606778 167817 2248 9000 7962 0 759881 570198 59835 2627 8000 17882 0 606778 499867 82997 3762 8000 8428 0 570198 0 0 1 0 0 0 3732524 3732524 0 57263307 26205675 31057632 0 0 0 0 0 4127595 2676336 1451259 0 3564073 2490599 1073474 37314889 MASTER PLAN CONSTRUCTION IN PROGRES 6537082 ISSUANCE COSTS - NET 542782 PRE-OPEN ADVERTISING VILLAS - NET 294209 7374073 0 Provision for Interest Rate SWAP 651597 Deposits 1606278 Entrance Fee Refunds Payable 296472 Gift Annuity Payable 155492 Refundable Entrance Fee - R.O.C. 3505790 6215629 Schedule D, Part V, Line 4 EXPLANATION: THE FVD RESIDENTS' BENEVOLENT FUND WAS CREATED AS A PERMANENT FUND, ALLOWING FOR ONLY THE INTEREST INCOME TO BE SPENT. THE PRIMARY USE OF THE FUND IS TO PROVIDE REVENUE TO OFFSET THE COST FOR LIFE CARE RESIDENTS WHO HAVE OUTLIVED THEIR PERSONAL FINANCIAL MEANS. THE JOHN SCHWARCK SCHOLARSHIP FUND WAS CREATED TO SUPPORT SELECTED ASSOCIATES AND/OR THEIR LEGAL DEPENDENTS AS THEY SEEK A COLLEGE EDUCATION. THE FVD HEALTH SERVICES FUND WAS CREATED TO PROVIDE ADDITIONAL FINANCIAL RESOURCES TO HELP SECURE THE PRESENT AND FUTURE HEALTH AND COMFORT OF THE RESIDENTS. UNLESS OTHERWISE INDICATED, CONTRIBUTIONS TO THE FVD HEALTH SERVICES FUND WILL BE DIRECTED TOWARDS PURCHASING SPECIALIZED EQUIPMENT, FACILITIES IMPROVEMENTS AND RELATED EXPENDITURES IN THE FOLLOWING AREAS: 1. HEALTH CENTER, 2. ASSISTED LIVING, 3. HOME CARE SERVICES, AND 4. WELLNESS CENTER. 1 JOHN SCHWARCK SCHOLARSHIPS AWARDED TO ASSOCIATES OF FRIENDSHIP VILLAGE OF DUBLIN OHIO INC. AND/OR DEPENDANTS OF FVD ASSOCIATES WHO ARE PURSUING A COLLEGE EDUCATION. 5 12500 Schedule I, Part I, Line 2 IT IS THE ROLE OF THE SCHOLARSHIP SELECTION COMMITTEE TO DETERMINE WHICH CANDIDATE(S) FROM A QUALIFIED POOL OF APPLICANTS WILL RECEIVE SCHOLARSHIPS IN ANY GIVEN YEAR. IT IS THE ROLE OF THE CHARITABLE GIVING ADVISORY COMMITTEE TO DETERMINE AGGREGATE AMOUNTS TO BE DISTRIBUTED BY THE SCHOLARSHIP SELECTION COMMITTEE. THE COMMITTEE WILL REVIEW APPLICATIONS AND THE SCHOOLS LISTED TO DETERMINE ELIGIBILITY. FRIENDSHIP VILLAGE OF DUBLIN OHIO INC. FOLLOWS ITS JOHN SCHWARCK SCHOLARSHIP FUND SPENDING PROCEDURE THROUGHOUT THE ENTIRE PROCESS FROM SELECTION TO ISSUANCE OF FUNDS. FUNDS ARE ISSUED VIA A CHECK MADE PAYABLE TO BOTH THE RECIPIENT AND THE COLLEGE OR UNIVERSITY THEY ARE ATTENDING SO SCHOLARSHIPS ARE USED FOR THEIR INTENDED PURPOSES. X X 0 0 0 0 0 0 0 0 0 JERRY KUYOTH EXECUTIVE DIRECTOR 146499 0 47230 0 1284 0 26207 0 1882 0 223102 0 0 0 A FRANKLIN COUNTY OHIO 316400067 353180GG1 2004-09-01 13805000 REFUND AND RETIRE THE OUTSTANDING PRINCIPAL AMOUNT OF THE 1997 REVENUE BOND 0 0 0 B FRANKLIN COUNTY OHIO 316400067 353180JQ6 2014-12-03 25004402 REFUND AND RETIRE THE OUTSTANDING PRINCIPAL OF THE 2004B REVENUE BONDS & FUND CONSTRUCTION COSTS OF 0 0 0 A 0 0 13805000 0 0 13418895 276000 98803 0 13418895 0 0 1991 1 0 1 1 B 0 0 25004650 0 0 17460000 500088 0 0 7044314 0 0 2015 1 0 1 1 A 0 0 0 0 0.00 0.00 0.00 0 0 0 B 0 0 0 0 0 0 0 0 0 0 A 0 0 1 1 1 1 MORGAN STANLEY 17 0 0 0 0 0 B 0 1 1 0 0 0 0 0 0 A 0 B 0 Schedule K, Part I, Column a-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO (A) ISSUER NAME: FRANKLIN COUNTY, OHIO Schedule K, Part I, Column a-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO ISSUER NAME: FRANKLIN COUNTY, OHIO Schedule K, Part I, Column f-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO (F) DESCRIPTION OF PURPOSE: REFUND AND RETIRE THE OUTSTANDING PRINCIPAL AMOUNT OF THE 1997 REVENUE BONDS. Schedule K, Part I, Column f-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO DESCRIPTION OF PURPOSE: REFUND AND RETIRE THE OUTSTANDING PRINCIPAL OF THE 2004B REVENUE BONDS, FUND CONSTRUCTION COSTS OF CERTAIN INDEPENDENT LIVING VILLAS, AND ROUTINE CAPITAL EXPENDITURES FOR 2014, 2015, AND 2016. Schedule K, Part II, Line 3-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO ISSUE PRICE ($25,004,402) AND INVESTMENT EARNINGS ($248) Schedule K, Part III, Line 3a-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO THE ORGANIZATION HAS ONE MANAGEMENT AGREEMENT WHICH HAS BEEN DETERMINED TO COMPLY WITH REV. PROC. 97-13, AS MODIFIED BY REV. PROC. 2001-39, AND AMPLIFIED BY NOTICE 2014-67. Schedule K, Part III, Line 9-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION IS IN THE PROCESS OF REVIEWING DRAFT PROCEDURES. Schedule K, Part III, Line 9-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION IS IN THE PROCESS OF REVIEWING DRAFT PROCEDURES. Schedule K, Part IV, Line 2c-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO DATE THE REBATE COMPUTATION WAS PERFORMED: MAY 26, 2014. Schedule K, Part V-09/01/2004 13,805,000 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION IS CURRENTLY REVIEWING DRAFT PROCEDURES. Schedule K, Part V-12/03/2014 25,004,402 FRANKLIN COUNTY OHIO WHILE THE ORGANIZATION HAS NOT ADOPTED WRITTEN POST ISSUANCE COMPLIANCE PROCEDURES YET, THE ORGANIZATION IS CURRENTLY REVIEWING DRAFT PROCEDURES. Form 990, Part I, Line 1 DESCRIPTION OF ORGANIZATION MISSION: PROVIDED 248 INDEPENDENT LIVING RESIDENCY APARTMENTS, 46 ASSISTED LIVING RESIDENCY APARTMENTS (INCLUDING 13 MEMORY LOSS UNITS), AND MAINTAINED A 60 BED SKILLED NURSING FACILITY. PROVIDED NON-SKILLED HOME HEALTH SERVICES TO OUR RESIDENTS. PROVIDED ACTIVITIES AND PROGRAMS, INCLUDING A WELLNESS CENTER, TO ENHANCE RESIDENT OVERALL HEALTH AND QUALITY OF LIFE. PROVIDED USE OF FACILITIES TO RESIDENT FAMILIES FOR FAMILY GATHERINGS, MEMORIAL SERVICES, AND TO VARIOUS AGED AND HEALTH ASSOCIATIONS FOR MEDICAL EVENTS AND EXHIBITS. Form 990, Part VI, Section A, Line 3 EXPLANATION: LIFE CARE SERVICES PROVIDES THE EXECUTIVE DIRECTOR FOR THE ORGANIZATION. JERRY KUYOTH SERVED AS EXECUTIVE DIRECTOR FOR FRIENDSHIP VILLAGE OF DUBLIN DURING THIS PERIOD. LIFE CARE SERVICES WAS COMPENSATED BY THE VILLAGE DURING 2015 IN THE AMOUNT OF $223,102 FOR HIS SERVICES. IN ADDITION, LIFE CARE SERVICES PROVIDES ACCOUNTING SOFTWARE, CLINCIAL SOFTWARE, IT SUPPORT, HUMAN RESOURCES, AND OTHER SUPPORT SERVICES. Form 990, Part VI, Section B, Line 11b EXPLANATION: THE FULL BOARD OF TRUSTEES RECEIVES A COPY FOR REVIEW PRIOR TO FILING BUT THE FINANCE AND INSURANCE COMMITTEE OF THE BOARD IS DELEGATED THE RESPONSIBILITY OF FULL REVIEW WITH THE EXECUTIVE DIRECTOR AND DIRECTOR OF FINANCE. Form 990, Part VI, Section B, Line 12c EXPLANATION: ALL CLASSES OF ASSOCIATES ARE INCLUDED IN THE CONFLICT OF INTEREST POLICY. TRAINING IS PROVIDED ANNUALLY TO ALL ASSOCIATES ON DISCLOSURE OF UNETHICAL PRACTICES AND A POSITIVE WORKFORCE ENVIRONMENT. THIS PROCESS IS GOVERNED BY DEPARTMENT DIRECTORS AND THE EXECUTIVE DIRECTOR. SHOULD A CONFLICT OF INTEREST BE IDENTIFIED, IT IS DISCUSSED WITH THE EXECUTIVE DIRECTOR AND NECESSARY ACTION IS TAKEN TO ELIMINATE THE CONFLICT OF INTEREST. A QUESTIONNAIRE IS SENT TO ALL BOARD MEMBERS ANNUALLY IN DECEMBER AS WELL AS NEW BOARD MEMBERS IN THE FIRST MONTH THEY JOIN THE BOARD OF DIRECTORS REQUIRING A SIGNATURE OF THE FORM AND DISCLOSURE OF ANY CONFLICT OF INTEREST. THESE FORMS ARE MONITORED BY THE BOARD SECRETARY. IF A BOARD MEMBER HAS A CONFLICT OF INTEREST ON A SPECIFIC ISSUE, THEY ABSTAIN FROM VOTING. Form 990, Part VI, Section B, Line 15 EXPLANATION: THE EXECUTIVE DIRECTOR IS EVALUATED ANNUALLY BY VARIOUS LEVELS WITHIN LIFE CARE SERVICES(LCS), INCLUDING HIS IMMEDIATE SUPERVISOR WHO IS AN LCS REGIONAL DIRECTOR. INPUT IS PROVIDED TO THE REGIONAL DIRECTOR FROM THE BOARD OF TRUSTEES AND OTHER KEY LEADERSHIP WITHIN THE VILLAGE. AS PART OF THE REVIEW PROCESS, LCS PERFORMS INDUSTRY WIDE WAGE COMPARISON FOR EXECUTIVE DIRECTOR POSITIONS IN SIMILAR SIZE AND FUNCTION ORGANIZATIONS. THE PROCESS INCLUDES SUBSTANIATION OF THE DELIBERATION AND DECISION MAKING PROCESS. THE EVALUTION WAS LAST PERFORMED IN 2016. THE DEPARTMENT DIRECTORS ARE EVALUATED ANNUALLY BY THE EXECUTIVE DIRECTOR. A LEADING AGE SALARY SURVEY AND BENEFITS SURVEY IS USED AS REFERENCE TO DETERMINE DIRECTOR COMPENSATION. COMPENSATION DECISIONS ARE REFLECTED IN FORMAL EVALUTION DOCUMENTS. THIS PROCESS WAS LAST UNDERTAKEN IN 2016. Form 990, Part VI, Section C, Line 19 EXPLANATION: GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS ARE AVAILABLE FOR PUBLIC REVIEW BY APPOINTMENT AT 6000 RIVERSIDE DRIVE, DUBLIN, OHIO 43017. Form 990, Part XI, Line 9 EXPLANATION: NET UNREALIZED GAIN ON SWAP FAIR MARKET VALUE ADJUSTMENT ($16,469) AND GIFT ANNUITY PRESENT VALUE ADJUSTMENT (-$27,002). Form 990, Part XII, Line 2c EXPLANATION: THE ORGANIZATION HAS A FINANCE AND INSURANCE COMMITTEE WHICH OVERSEES THE AUDIT OF THE FINANCIAL STATEMENTS AND IS INVOLVED IN SELECTION OF THE INDEPENDENT ACCOUNTING FIRM WHICH COMPLETES THE AUDIT. POLICY REQUIRES AN EXECUTIVE SESSION POST AUDIT SUMMARY DISCUSSION IN WHICH THE COMMITTEE MEMBERS SPEAK WITH THE AUDITORS WITHOUT MANAGEMENT PRESENT. THERE IS NO CHANGE IN THE PROCESS FROM THE PREVIOUS YEAR. BIRCHTON LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 261186696 HOLD AND DEVELOP REAL ESTATE OH 116989 1493597 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC TRIANGLE HOUSING LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 HOLD AND DEVELOP REAL ESTATE OH 0 157408 BIRCHTON LLC FRIENDSHIP VILLAGE OF DUBLIN HOME CARE LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 471284626 HOME CARE SERVICES OH 614520 242264 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC FRIENDSHIP AT HOME LLC 6000 RIVERSIDE DRIVE DUBLIN OH 43017 474000431 PROVIDE CONTINUING CARE AT HOME FOR LOCAL SENIORS OH 25733 301134 FRIENDSHIP VILLAGE OF DUBLIN OHIO INC